THOUGH FIRST described in 1911 (Churchman),1 the limy bile syndrome remains obscure. It is characterized by the presence of radiopaque material within the gallbladder or common duct.2,3 On a single x-ray film it may cast a shadow indistinguishable from a normal cholecystogram.
Limy bile is a synonym of milk of calcium bile of Volkmann.4 This lime or calcium is usually calcium carbonate, less often, calcium phosphate, or calcium bilirubinate. Its source remains disputed. Three somewhat divergent origins, however, have been suggested. It may be precipitated from bile by an obstructed gallbladder5; it may be secreted by an abnormal gallbladder6; or it may be a product of abnormal liver function.7 Some clinical and experimental evidence tends to support each view. Almost all agree, however, that it is associated with a degree of cystic duct obstruction.8 Cystic duct stones are present in 75% of cases.
Besic LR, Krawzoff G, Tiesenga MF. Limy Bile Syndrome. JAMA. 1965;193(3):245–246. doi:10.1001/jama.1965.03090030067028